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General Healthcare Maintenance

It is important to continue general health maintenance. While working with your gastroenterologist, also remember to speak with your primary care health care provider about other important issues including:

Vaccinations: Adults with IBD should generally follow the same vaccination schedules as the general population. The only exceptions are people on immunomodulators and anti-TNF therapy, who should not receive any live virus vaccines. The best time to vaccinate is when someone is newly diagnosed with IBD, before any immunosuppressive therapy has begun.

Oral health: Among the extraintestinal symptoms of IBD are aphthous ulcers in the mouth, also known as canker sores. These may be caused by the IBD itself, or be secondary to nutritional deficiencies. Although not serious, these ulcers can be quite painful. Mouth rinses and other topical treatments may help relieve the discomfort. Please remember to also see your dentist for routine dental care.

Tuberculosis screening: Screening should be done before immunosuppressive treatment is begun because immunosuppressants can affect the outcome of the test.

Periodic blood testing: The frequency and type of tests depend on IBD medication use and any other medical conditions that exist. A baseline set of tests before starting IBD therapy is helpful to determine medication-associated abnormalities and benefits.

Colonoscopies: These are key in the management of IBD—determining the severity and extent of disease, monitoring the effectiveness of therapy, checking for postoperative recurrence, and screening for colorectal cancer.

Tobacco cessation: In addition to raising cancer risk, cigarette smoking has adverse effects on lung and heart health. It also has a negative effect on people with Crohn’s disease.

Osteoporosis monitoring: Osteoporosis can be a significant medical problem in people with IBD, whose reduced bone mineral densities put them at increased risk for fractures. Bone loss can occur as a result of chronic inflammation and/or with the use of steroids. Most bone loss occurs in the first six months of corticosteroid use. The best course of action in terms of osteoporosis prevention is to minimize steroid use if possible, relying instead on steroid-sparing agents such as azathioprine (an immunomodulator) and anti-TNF medications where appropriate. Supplementation with calcium, vitamin D, and the use of drugs called bisphosphonates while being treated with prednisone and other steroids can also be helpful in protecting your bone health.

Blood pressure screening: Because of some of the medications used in treatment, particularly corticosteroids and cyclosporine, people with IBD who are taking these medications may have an increased risk of secondary hypertension (high blood pressure). In most instances, the hypertension resolves once the medication is discontinued.

Depression: Various factors—including the chronic relapsing nature of the disease and some of the medications used as treatment—make people with IBD particularly prone to depression, affecting between 15 and 35 percent of patients. Screening and appropriate medical treatment are necessary.

Ophthalmologic screening: Corticosteroid use may increase the risk of glaucoma as well as cause some temporary vision changes. In addition, extraintestinal symptoms of IBD may involve the eye.

Cancer screening: Some IBD patients are at increased risk for colon cancer and will need frequent colonoscopies for screening. People with IBD should follow the current recommendations for regular screenings for breast and prostate cancer. Women with IBD on immunomodulator therapy are at increased risk for abnormal pap smears (precancerous findings). Men and women on immunomodulator therapy are at increased risk of certain skin cancers. Careful monitoring and evaluation are recommended.

Please use the health care maintenance chart provided on the next page for your records.

*Live virus vaccines are contraindicated in patients on biologic therapy. Therefore, they should be given prior to initiating biologics.

Updated: 12/11/09

For further information, call CCFA at our IBD Help Center: 888.MY.GUT.PAIN (888.694.8872).

The Crohn's & Colitis Foundation of America provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization's resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.